4 - Nausea / Vomiting Flashcards
Emetrol
Phosphorylated Carbohydrate Solution
Dose / Indication
Fructose, dextrose, orthophosphoric acid
ANTIEMETIC
upset stomach / food indiscretions / emotional upset
Adults:
15-30ml q15min
(1-2 Tablespoons), until nausea subsides
Max 5 doses in 1 hour, no longer than 1 hour
Emetrol
Consultation
Fructose, dextrose, orthophosphoric acid
- Do not Dilute solution or Drink Fluids prior to use*
- Wait 15 minutes prior to last dose*
- DNT for more than 1 hour (5 doses)*
not for children or newborns
Emetrol
Adverse Effects
Phosphorylated Carbohydrates
Abdominal Cramping
Diarrhea
15-30ml q15
Emetrol
CI’s & Precautions
Phosphorylated Carbohydrates
- DNU in newborns / children unless DR*
- DNU w/ Diabetics high SUGAR content*
- DNU w/ Hereditary fructose intolerance (HFI)*
- <5 doses in 1 hour*
15-30ml q15min
Bonine / Meclizine
Indication
Motion Sickness Medication
chewable / 25mg tablets
Treats & prevents adults w/
Nausea / Dizziness / Vomiting
(associated w/ motion sickness)
1-2t QD, 1 hr before activity
Meclizine / Cyclizine
Bonine
Dose
1-2 Tablets (25-50mg) QD
1 Hour before
engaging in activity that causes motion sickness
Can be CHEWED OR SWALLOWED
Bonine / Meclizine
Consultation
Drowsiness
Avoid Alcohol / alertness needed in activities
Clear View
PMH: Asthma / Glaucoma / BPH
BONINE / Meclizine / Cyclizine
Adverse Effects
Drowsiness
Dry Mouth
BONINE / Meclizine / Cyclizine
CI’s + PC’s
Paradoxical Stimulatory in children
- DNU in children <12 y/o*
- DNU in pt w/ PMH of BPH/asthma/urination issue/glaucoma*
CNS Depression - Alcohol / depressants
PCAT - B
DRAMAMINE
dimenhydrinite / meclizine / ginger
Indication
Motion Sickness Medication
Relief of Nausea / Dizziness / Vomiting (MS symptoms)
50Tab / Chewable / Kids 25mg
1-2t (50-100mg) q46 or 30min b4
max 8tab in 24 hrs
Meclizine Vs Other MS medications
Meclizine may be LESS SEDATING
DRAMAMINE
dimenhydrinite / meclizine / ginger
DOSE
1-2tabs (50-100mg) Q46
or
30 minutes b4 activity
Max 8 Tabs (400mg) in 24 hours
less drowsy formulation only for adults, 2 tabs max
DRAMAMINE
dimenhydrinite / meclizine / ginger
Consultation
Same As Bonine/meclizine
Drowsiness
Avoid Alcohol / alertness needed in activities
Clear View
PMH: Asthma / Glaucoma / BPH
DRAMAMINE
dimenhydrinite / meclizine / ginger
AE’s
Same as Bonine / meclizine
Drowsiness
Dry Mouth
ANTICHOLINERGIC
DRAMAMINE
dimenhydrinite / meclizine / ginger
CI’s + PC’s
Similar to Bonine
Paradoxical Stimulatory in children
DNU for children <2 y/o
(vs 12 y/o with meclizine)
CNS depression - alcohol + CNS depressants
PMH of asthma / glaucoma / BPH
PC - B
Symptoms of NV
Nausea
feeling of needing to vomit
Retching
involuntary diaphragm/ab contractions
Vomiting
Rapid/forceful expulsion of GI tract contents
Types of N/V
Motion Sickness
NVP (pregnancy)
Overeating / eating disagreable foods
Food Poisoning / Viral Gastroenteritis
Medication Use
Episodic / Situational NV
Complications of NV
Dehydration
Electrolyte / A-B Imbalance
Esophageal Tears
Aspiration / Malnutrition
Diaphragmatic HERNIATION
Mallory-Weiss Syndrome
Exclusions for Self-Treatment (EX-S-T)
N/V
Head Injury
Urine Ketones / High BG
Food poisoning >24 hours
ab pain in mid or right lower quadrent
BLOOD in vomitus
Yellow skin/eye
Dark Urine
STIFF NECK
EX-ST
NV for CHILDREN
Severe DEHYDRATION
caregiver unable/willing to manage at home
Motion Sickness Facts
Better to PREVENT vs treating
rare in kids <2 y/o, more common in WOMEN
Overstimulation of Labrinth apparatus
fluid in canal moves -> postural adjustment / 2 axis
-> unusual motion patterns
Motion Sickness Treatment
Antihistamines: Meclizine / Cyclizine / Dimenhydrinate
Bonine / Dramamine
Meclizine may be less sedating
Motion Sickness Prevention
- Avoid Reading during Travel*
- Avoid excess Food / Alcohol before&during travel*
Focus on the line of vision fairly straight ahead
avoid Strong odors
Drive vehicle
N/V in PREGNANCY
50-80% in EARLY pregnancy
subsides by 20th week in 80% of women
MultiFactoral
Accupressure
GINGER
NVP Treatment
Diclegis (Pyridoxine + Doxylamine) Extended Release
RX ONLY
Pyridoxine 10-25mg TID +/- Doxylamine 10mg TID
This is OTC
Doxylamine / dimenhydrinate effective
but not a lot known about fetal outcomes
Preventing NVP
Fresh Air
Dry crackers 10-15 min b4 getting out of bed (slowly)
4-5 small meals, do not overeat
Avoid Fluids or Soups at meals
When nauseated, sip co2 beverages / fruit juice
avoid greasy / spicy / fatty / acidic foods
Eat Dry / Bland / High-protein foods / Chilled
Overeating & Treatment
Gut Distention + Decreased GI emptying
–> Stimulation of mechanoreceptors
Emetrol - 15-30ml q15
(phosphorlated carb solution)
(HYPERosmolar)
acts on GI to decrease smooth muscle contraction
delay gastric emptying time
Acute Viral Gastroenteritis
Inflammation of stomach / SI
Presents w/ Acute Vomiting + Diarrhea
Self-limiting - Gone after 24 Hours
can be serious with children due to dehydration
S/S of DEHYDRATION
in children
Sunken Eyes / Fontanelle
Dry eyes, Decreased skin tugor
Dark /little Urine
Absence of tears
Weight LOSS (small abdominal size)
Lethargy / sleepiness / decreased alertness / Irritability
difficulty waking child / lightheaded
Treatment for Dehydration
ORS (oral rehydration therapy)
Glucose Based ORS (gatorade)
more ISOMOLAR, more effective at rehydrating vs water
Fluid absorption may be COMPRIMISED in pts with:
continuous vomiting > more difficult than diarrhea
ORT Ideal Osmolarity
245
(mOs m/L)
WHO-ORS
Pedialyte = 249
Gatorade = 330 (lot of sugar)
Gatorade as ORT
OSM = 330 (close to 245)
But a lot of SUGAR
too much sugar -> DRY in GI tract
ultimately want Sugar:Sodium ratio of 3:1
ORT for Minimal Dehydration
Children <10kg: 60-120ml
after each vomiting episode
Children >10kg: 120-240ml
after “
if severe _REFER to ED for IV fluid replacement_
ORT for Mild-Moderate Dehydration
Children:
50-100ml/kg
OVER 3-4 hours
Weight based, over 3-4 hours
if severe REFER to ED for IV fluid replacement
ORT for ADULTS
replace
30-50% of fluids lost
in first 24 hours
mainly gauge how you feel
drink ORS
Pedialyte Freezer Pops
Taste much better when COLD
Offered 10 min after last episode of vomiting
5ml q5min for children
15ml q5min for older children / adults
Complementary Therapy
for NV
Ginger
250mg (root) po QID for NVP / MS / Surgery
Accupressure
P6 point on wrist, wristband 10min TID or continuously
Aromatherapy
Peppermint Oil / Isopropyl Alcohol
Determining Dehydration in Children
Weight loss / Decrease in abdominal size
<3% (minimal),
3-9% (mild-moderate),
>9% (severe)
OTC NVP Treatment
& Dose
Pyridoxine 10-25mg TID
with or without
Doxylamine 10mg TID
This is OTC
